A goal of human service agencies may be to have more person centered documentation of events in an individual's life. The documentation may contain video, audio, or sensor telemetry of events.
There may be a need to not delete stored data to preserve data integrity. This may be a particular issue with Protected Health Information (PHI) or other information required for compliance with federal or government regulations.
Having video of an actual situation related to a person may be a key component for person centered documentation. For individuals with intellectual or cognitive disabilities who are receiving support from others there is a challenge to make sure that their goals and opinions are properly represented. There is also a need to make sure that once data is stored it is not selectively deleted. In many cases these individuals are receiving support from multiple agencies with multiple oversights and monitoring organizations.
In applications requiring proof of positive or negative individual satisfaction, proof of service delivery, time, location and meeting individual goals for people with intellectual and/or cognitive disabilities who have guardians and or funded caregivers, or monitored by funding agencies, the state of the art is paper or text based documentation perhaps with some photographs attached. A significant feature of laws such as HIPAA is the maintenance of a documentation trail of who has seen pieces of information, where the information came from and the non-destruction of PHI once information is saved. This may be a problem for video, audio, sensor and other documentation.
Multiple cameras with up to 24 hour by 7 day a week high definition, 3D or other high quality storage may be quite expensive to maintain. There could be many hours of storage where either nothing has occurred or nothing perceived as significant has occurred. In certain instances, perhaps with abuse and neglect, what is significant may be determined based on what occurred subsequently.
Movable cameras, such as those attached to a gyroscopic robot device may also be used to follow and monitor an individual during the course of his or her day.
If video regarding an individual is saved, that information may not be able to be deleted based on law or a concern about the loss of data integrity of other data and video in a documentation system. If video is saved in a high quality format which is not needed for documentation this may become costly in terms of storage costs and difficult in terms of managing a large amount of video files. If video is not saved in high quality formats then key information might be missing to make video taken of certain medical or abuse situations unusable or unenforceable.
Typically proof of service delivery, individual satisfaction of service provided and achievement of individual goals is documented using either paper or electronic formats. The desired information is entered on paper forms or some form of electronic database. These methods are prone to information which does not accurately reflect what happened. Someone might misremember all details of event either intentionally or unintentionally. There may be space limits on space in certain forms. Something might have occurred when no one was around to see what occurred. Something might have been observed by someone without the verbal or cognitive capability to fully describe what occurred. Someone might be describing something in a manner to cover up what actually occurred. There might be two or more people with different interpretations of what occurred. Video documentation could reduce or eliminate many of these problems.
Different staff, consultants, family members and others may either inaccurately interpret or falsely document information about an individual's satisfaction, achievement or additional responses. These are challenges with the current system of static dropdown choices answers, rating systems or defined check boxes to questions.
In addition, organizations providing these services work with significant budgetary issues. While most agencies work hard to provide excellent services, there are some agencies which do not have the same reputation, service quality or training and it is important to be able to have accurate documentation of service delivery and achievement of goals. It is a challenge for people with intellectual and/or cognitive disabilities to have accurate reporting on the achievement of goals, satisfaction of service received, or potential problems such as abuse and neglect.
There may also be situations where staff may be accused of abuse and neglect or not performing certain tasks. By having a rules based video saving system staff can have video and other documentation to help prove either the absence of wrong activity or the positive provision of proper services. There are many staff and family members accused of wrongdoing which has financial and reputational consequences which this process could avoid.
There are many current, significant issues with the prevention of abuse and neglect of individuals in this country receiving healthcare services. Having documentation by the same staff, consultants, or family of who might be causing the abuse and neglect is not as optimal as having the video showing the care, services and relationships. This need for accurately recording these activities is a challenge with paper based documentation—the current standard in the industry—when it cannot be independently filled out and submitted by a person who is the subject of the documentation. It can also be a challenge when a staff can video an individual and then submit that video after the fact depending on the answer given. This presents constant oversight of all treatment, both positive and negative, and has the potential to result in only the documentation of positive results, thus blanketing any negative issues from coming to light.
There are issues where different agencies, individuals, staff, funding agencies, guardians or others may have documentation goals or requirements which are not known to a staff member or other person providing service or support to an individual. These could relate to issues ranging from proof of service delivery for funding reimbursement to monitoring staff for potential abuse and neglect to individual person centered goals to medication and behavioral conditions. A broader real time interpretation of data in a person's files across multiple caseloads and roles of access could provide a changed requirement for data and video to be stored.
The proposed solution provides a method for saving and storing data without permitting any deletion or destruction of data after data is saved. Video or audio are processed by a range of input devices including direct connection of a camera, phone, pc, smartphone, mobile device or other device connected securely to a central physical location over the internet or equivalent. Video or audio regarding the target individual would preferably be transferred with a secure connection and analyzed before being stored and saved.
Once data is saved it could be in the system for a minimum of a preset period or number of years without the ability of any user to delete or destroy the data. This would create an audit trail and integrity to the data.
The data would be able to be accessed by individuals or staff based on caseloads and roles related to individuals in the video as well as actions which have occurred. The system could automatically determine these access levels based on interpretation of events in the video. The system could determine who is in the video based on a variety of factors including biometrics, passwords, rolling key encryption, secure access cards, etc. The system might not need to know who is in the system to make a decision on whether and in what format to save. For example the system might only have data on someone brushing their teeth if it was part of an individual plan and noted to be saved in video for a given individual, however if there were evidence of abuse or violence the system could have rules to save video if certain events occurred even without knowing the individuals in the video.
The system would have the ability to tag or change tags on individuals subsequent to the saving of the video. The system would document the various individuals ascribed to be in the video. These would be logged and tracked for future audit or review.
Documentation is particularly challenging for individuals with intellectual, cognitive, and developmental disabilities, which could be lifelong or temporary conditions with varying degrees of impairments. Individuals may have more emergencies and also be subject to more instances of abuse and neglect. They also may require daily documentation of goals, tasks and objectives. Agencies providing these services may only get paid upon proof of service delivery and satisfaction by the individual. Government or other funding agencies often question activities and withhold or reduce funding because of questionable documentation of activities or because documentation was not done co-terminally with the provision of services.
Certain religious members have a particular problem because of provisions of writing or using electronic devices during certain holidays or other periods. This system would permit information to be saved and then additional analysis provided later after the religious observance.
Access to Personal Health Information (“PHI”) about health and related conditions is strictly regulated by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the American Recovery and Reinvestment Act of 2009 (“ARRA”), and Health Information Technology for Economic and Clinical Health Act (“HITECH”) and other state and federal regulations which complicates providing support and services including analyzing and reviewing documentation.
In addition funding and reimbursement regulations are set by state, county and other government agencies as well as non-profit and for-profit organizations. These regulations can provide specific requirements for activities to occur in order to receive reimbursement. The system can be configured to ensure that all processing of data is consistent with these and other requirements.
The issues here are not only related to people with cognitive disabilities. There have been instances or allegations of abuse and neglect by teachers, coaches, job supervisors or others in general society. This system can provide a method to help provide either the occurrence or non-occurrence of any activity that can be recognized by the system.
This method allows for notification to staff or others based on caseloads and super roles and based on the event which actually occurred. Only people who would have access to an individual and to the type of information based on the information in the video would have access to see all or a portion of the video as appropriate.
This method allows for the situation where different staff members observe an individual doing the same action or responding in a certain way and each staff member might interpret that information and document it differently. Given that an individual might have a lifelong condition and staff members can be transitory and thus have limited information, there exists a problem with the information flow available to a staff member. Because documentation is being saved and analyzed from video information there is less staff interpretation of actual facts.
This method allows the checking of requirements on how to save video (after it is in a temporary condition but not yet saved) against individuals plans, person centered goals, previous notes and documentation in the system, staffing issues, and other data requirements. Where a pre-specified set of criteria are met, then temporary data can be moved to a more permanent store, as required.
In the face of such challenges it becomes difficult for care providers to both ensure satisfaction of service provided to the individual and proof of service delivery provided to an individual.
Similar situations exist in other industries. Situations with other cognitive impairments which might affect driving or other actions might need to be interpreted based on the individuals intent and capabilities.
Information can be generated from a video, tactile, thermal, electrochemical sensor, body worn sensors or audio capture system (including phones, computers, and other commercially available devices). The information is preferably captured and generated in real time. This eliminates the ability of a staff member to edit or only upload data which generates desired responses.
If potential for abuse and neglect is determined a specified subset of people based on caseloads and defined access roles, called super roles may view information as appropriate to review the situation. One benefit of the system is that the system can look for abuse and neglect across multiple caseloads and super roles based on predetermined rules.
Other potential applications for this automated processing include, but are not limited to, monitoring of public facilities such as train stations, malls, and airports; monitoring of private spaces such as houses, apartments; monitoring of secure areas such as offices and operations centers; monitoring of roadways and traffic patterns on those roadways, and others. Essentially any place where activity may be recorded and analyzed by automated means according to a defined set of rules.
Because the invention includes an intermediate buffer between a healthcare data-capturing device and the memory for storage of that data, the invention represents an improvement in computer technology as well as an improvement in the way computers are used to process electronic healthcare data. Furthermore, no conventional electronic healthcare data includes a rule-based way of determining, prior to storage, whether the data should or is required to be stored.